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Comparison of basilar and axial sesamoidean approaches for digital flexor tendon sheath synoviocentesis and injection in horses

Richard A. Rocconi DVM1 and Sarah N. Sampson DVM, PhD, DACVS2
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  • 1 Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762.
  • | 2 Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762.

Abstract

Objective—To define a method for the basilar sesamoidean approach (BSA) to the digital flexor tendon sheath (DFTS) in horses and compare it with the axial sesamoidean approach (ASA) for DFTS synoviocentesis and injection.

Design—Evaluation study.

Animals—12 healthy adult mares without evidence of abnormalities related to the lower limbs.

Procedures—Each horse had 1 forelimb and 1 hind limb assigned to each DFTS approach (basilar vs axial, relative to the proximal sesamoid bones) in a Latin square design. The order of horses and of limb injection for each horse was randomly selected. All procedures were performed in standing sedated horses. The number of attempts to place a needle in the DFTS, presence of synovial fluid in the needle hub, time for DFTS injection, and number of accurate injections of sterile contrast material into the DFTS (evaluated by means of radiography) were compared between methods.

Results—Median time for injection was significantly shorter for the BSA, compared with the ASA. The median number of times the needle was redirected was also significantly less for the BSA. Odds of obtaining synovial fluid via the BSA were 5.7 times as great as for the ASA (95% confidence interval, 1.2 to 278). Successful injection of contrast material into the DFTS did not differ significantly between the BSA (24/24 limbs) and ASA (23/24).

Conclusions and Clinical Relevance—The BSA was a useful method for DFTS synoviocentesis in the forelimbs and hind limbs of standing sedated horses and was superior to the ASA in most aspects. This approach to the DFTS should be considered when DFTS injection or synovial fluid retrieval is desired, particularly in horses with minimal DFTS effusion.

Abstract

Objective—To define a method for the basilar sesamoidean approach (BSA) to the digital flexor tendon sheath (DFTS) in horses and compare it with the axial sesamoidean approach (ASA) for DFTS synoviocentesis and injection.

Design—Evaluation study.

Animals—12 healthy adult mares without evidence of abnormalities related to the lower limbs.

Procedures—Each horse had 1 forelimb and 1 hind limb assigned to each DFTS approach (basilar vs axial, relative to the proximal sesamoid bones) in a Latin square design. The order of horses and of limb injection for each horse was randomly selected. All procedures were performed in standing sedated horses. The number of attempts to place a needle in the DFTS, presence of synovial fluid in the needle hub, time for DFTS injection, and number of accurate injections of sterile contrast material into the DFTS (evaluated by means of radiography) were compared between methods.

Results—Median time for injection was significantly shorter for the BSA, compared with the ASA. The median number of times the needle was redirected was also significantly less for the BSA. Odds of obtaining synovial fluid via the BSA were 5.7 times as great as for the ASA (95% confidence interval, 1.2 to 278). Successful injection of contrast material into the DFTS did not differ significantly between the BSA (24/24 limbs) and ASA (23/24).

Conclusions and Clinical Relevance—The BSA was a useful method for DFTS synoviocentesis in the forelimbs and hind limbs of standing sedated horses and was superior to the ASA in most aspects. This approach to the DFTS should be considered when DFTS injection or synovial fluid retrieval is desired, particularly in horses with minimal DFTS effusion.

Contributor Notes

Dr. Rocconi's present address is Southern Equine Associates, PO Box 190, Aubrey, TX 76227. Dr. Sampson's present address is Equine Surgery & Orthopedic Sports Medicine, 30323 Sierra Sunrise Dr, Exeter, CA 93221.

Funded by an intramural house officer research grant from the Mississippi State University College of Veterinary Medicine.

Presented in abstract form at the American College of Veterinary Surgeons Veterinary Symposium, National Harbor, Md, November 2012.

The authors thank Dr. Robert K. Schneider for development of the basilar sesamoid approach and Dr. Robert Wills for statistical analysis.

Address correspondence to Dr. Sampson (sampsondvm@gmail.com).